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What's changed? Yet another new Canadian lipid guideline


SNAP SAMP List 5 indications for statin therapy other than for primary prevention of cardiovascular disease (answers below)

DID YOU KNOW? The Canadian Cardiovascular Guidelines have released the 2016 Canadian lipid guidelines, which replace the 2012 edition. These are so new they’re still in press and haven’t yet been published, but you can read the preliminary version at the CCS website.

WHAT’S CHANGED?

Here are some of the changes in the new guidelines:

  • Fasting is now cruel and unusual punishment for your patients. Don’t make them fast for lipid measurements. Same goes for diabetes screening - screen with A1C if you are OK with charging the government more ($12.69 vs $1.46 for FBG).

  • Shared decision making is here - however this has been on the SOO for years

  • Stop Niacin. Yes it lowers lipids, but no it does not reduce mortality enough to justify its safety profile in nearly all patients. (Same goes for fibrates.)

  • Whom to treat is actually very similar to the 2012 guidelines. Avoid statins if Framingham < 10%. Actually - do one better on your exam - instead of just avoiding statins, recommend lifestyle modifications (exercise, Mediterranean diet) if Framingham < 10%. Summary slide

SO MANY GUIDELINES - WHAT TO STUDY?

As if there weren’t enough lipid guidelines out there, the Canadian Family Physician journal published their own 2015 version of Canadian lipid guidelines, which we reviewed in a previous blog post.

So when more than one guideline exists, which one do you need to know for the exam? The CFPC’s website answers this very question on their FAQ page:

“candidates should always answer according to what represents the most accepted good practice of family medicine at the time of the examination.”

(See the CCFP exam FAQ page for the full answer). ANSWERS:

Other than in primary prevention for patients with Framingham ≥ 10%, the 2016 CCS lipid guidelines recommend statins for patients with

  • Clinical atherosclerosis

  • AAA

  • Most patients with diabetes

  • CKD

  • LDL-C ≥ 5

Reference List

2016 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in the Adult

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